title: UKCCSG's germ cell tumour (GCT) studies: improving outcome for children with malignant extracranial non-gonadal tumours--carboplatin, etoposide, and bleomycin are effective and less toxic than previous regimens. United Kingdom Children's Cancer Study Group.
abstract: BACKGROUND
  We report the efficacy and late effects of carboplatin, etoposide, and bleomycin (JEB) for extracranial non-gonadal tumours (GCII, 1989-95) compared with the 5 previous regimens (GCI, 1979-1988) consisting of 3 vincristine, actinomycin, and cyclophosphamide (VAC) and 2 platinum-based protocols.
  
  
  RESULTS
  Median follow-up for 52 patients in the GCI study and 46 in GCII was 105 and 48 months, respectively. For GCI, 5- and 10-year actuarial survival was 63% (95% Confidence interval 50 to 75%) or 72% (57 to 83%) if 6 cases given low-dose VAC were excluded. For GCII, 5-year survival was significantly greater at 95% (83 to 99%), p = 0.01. Event-free survival was 46% at 5 years for GCI (33 to 59%) or 52% excluding the low-dose VAC cases (38 to 66%), while for GCII it was 87% (74 to 94%), p = 0.002. Five-year event-free survival of 21 children given cisplatin, etoposide, and bleomycin (BEP) in GCI was 57% (37 to 76%) compared with 87% (74 to 94%) for 46 given JEB in GCII, P = 0.02. Late effects in 30 evaluable survivors of GCI and 43 GCII included renal impairment in 6 in GCI and 0 in GCII and deafness in 11 and 4, respectively. Among 17 survivors of sacrococcygeal tumours treated in GCI, 4 have neuropathic bladder/bowel and another shortening of a leg. In GCII, 4 of 26 have neuropathic bladder/bowel with lower limb weakness in one.
  
  
  CONCLUSIONS
  We found JEB to be more effective and less toxic than our previous regimens. Some survivors of sacrococcygeal tumours have neurological late effects.
authors.affiliation: Oncology Department, Children's Hospital, Birmingham, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Mann
authors.forename: F
authors.initials: F
authors.lastname: Raafat
authors.forename: K
authors.initials: K
authors.lastname: Robinson
authors.forename: J
authors.initials: J
authors.lastname: Imeson
authors.forename: P
authors.initials: P
authors.lastname: Gornall
authors.forename: M
authors.initials: M
authors.lastname: Phillips
authors.forename: M
authors.initials: M
authors.lastname: Sokal
authors.forename: E
authors.initials: E
authors.lastname: Gray
authors.forename: P
authors.initials: P
authors.lastname: McKeever
authors.forename: A
authors.initials: A
authors.lastname: Oakhill
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018237:Germinoma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D001761:Bleomycin; D005047:Etoposide; D016190:Carboplatin; D002945:Cisplatin